Infections of the Posterior Segment: Ocular Tuberculosis

  • Ahmed M. Abu El-Asrar
  • Marwan Abouammoh
  • Hani S. Al-Mezaine
Chapter
First Online:
Part of the Essentials in Ophthalmology book series (ESSENTIALS)

Abstract

In recent years, ocular involvement due to tuberculosis has reemerged. Tuberculous uveitis is a readily treatable disease, and the consequences of delay in either ocular or systemic diagnosis can be very serious for the patient. It is important to have a high index of suspicion of the diagnosis in patients with unexplained chronic uveitis, and this will be influenced by the socioeconomic circumstances, family history, ethnic origin, and previous medical history of the patient. Treatment with antituberculous therapy combined with systemic corticosteroids induces resolution of inflammation with no recurrences after stopping antituberculous therapy and systemic corticosteroids.

References

  1. 1.
    Centers for Disease Control and Prevention. Case definitions for infectious conditions under public health surveillance. MMWR Recomm Rep. 1997;46:1–55.Google Scholar
  2. 2.
    Glassroth J, Robins AG, Snider DE. Tuberculosis in the 1980s. N Engl J Med. 1980;302:1441–50.PubMedCrossRefGoogle Scholar
  3. 3.
    Baydur A. The spectrum of extrapulmonary tuberculosis. West J Med. 1977;126:253–62.PubMedCentralPubMedGoogle Scholar
  4. 4.
    Kazokoglu H, Onal S, Tugal-Tutkun I, Mirza E, Akova Y, Ozyazgan Y, Soylu M, Batioglu F, Apaydin C. Demographic and clinical features of uveitis in tertiary centers in Turkey. Ophthalmic Epidemiol. 2008;15:285–93.PubMedCrossRefGoogle Scholar
  5. 5.
    Pathanapitoon K, Kunavisarut P, Ausayakhun S, Sirirungsi W, Rothova A. Uveitis in a tertiary ophthalmology centre in Thailand. Br J Ophthalmol. 2008;92:474–8.PubMedCrossRefGoogle Scholar
  6. 6.
    Khairallah M, Yahia SB, Ladjimi A, Messaoud R, Zaouali S, Attia S, Jenzeri S, Jelliti B. Pattern of uveitis in a referral centre in Tunisia, North Africa. Eye. 2007;21:33–9.PubMedCrossRefGoogle Scholar
  7. 7.
    Rathinam SR, Namperumalsamy P. Global variation and pattern changes in epidemiology of uveitis. Indian J Ophthalmol. 2007;55:173–83.PubMedCrossRefGoogle Scholar
  8. 8.
    Yang P, Zhang Z, Zhou H, Li B, Huang X, Gao Y, Zhu L, Ren Y, Klooster J, Kijlstra A. Clinical patterns and characteristics of uveitis in a tertiary canter for uveitis in China. Curr Eye Res. 2005;30(11):943–8.PubMedCrossRefGoogle Scholar
  9. 9.
    Sengun A, Karadag R, Karakurt A, Saricaoglu MS, Abdik O, Hasiripi H. Causes of uveitis in a referral hospital in Ankara, Turkey. Ocul Immunol Inflamm. 2005;13:45–50.PubMedCrossRefGoogle Scholar
  10. 10.
    Soheilian M, Heidari K, Yazdani S, Shahsavari M, Ahmadieh H, Dehghan M. Patterns of uveitis in a tertiary eye care center in Iran. Ocul Immunol Inflamm. 2004;12:297–310.PubMedCrossRefGoogle Scholar
  11. 11.
    Singh R, Gupta V, Gupta A. Pattern of uveitis in a referral eye clinic in north India. Indian J Ophthalmol. 2004;52:121–5.PubMedGoogle Scholar
  12. 12.
    Wakabayashi T, Morimura Y, Miyamoto Y, Okada AA. Changing pattern of intraocular inflammatory disease in Japan. Ocul Immunol Inflamm. 2003;11:277–86.PubMedCrossRefGoogle Scholar
  13. 13.
    Islam SM, Tabbara KF. Causes of uveitis at The Eye Center in Saudi Arabia: a retrospective review. Ophthalmic Epidemiol. 2002;9:239–49.PubMedCrossRefGoogle Scholar
  14. 14.
    Mercanti A, Parolini B, Bonora A, Lequaglie Q, Tomazzoli L. Epidemiology of endogenous uveitis in north-eastern Italy. Analysis of 655 new cases. Acta Ophthalmol Scand. 2001;79:64–8.PubMedCrossRefGoogle Scholar
  15. 15.
    KaimboWaKimbo D, Bifuko A, Dernouchamps JP, Missotten L. Chronic uveitis in Kinshasa (D R Congo). Bull Soc Belge Ophthalmol. 1998;270:95–100.Google Scholar
  16. 16.
    Kotake S, Furudate N, Sasamoto Y, Yoshikawa K, Goda C, Matsuda H. Characteristics of endogenous uveitis in Hokkaido, Japan. Graefes Arch Clin Exp Ophthalmol. 1997;235:5–9.PubMedCrossRefGoogle Scholar
  17. 17.
    Merrill PT, Kim J, Cox TA, Betor CC, McCallum RM, Jaffe GJ. Uveitis in southeastern United States. Curr Eye Res. 1997;16:865–74.PubMedCrossRefGoogle Scholar
  18. 18.
    Rodriguez A, Calonge M, Pedroza-Seres M, Akova YA, Messmer EM, D’Amico DJ, Foster CS. Referral pattern of uveitis in tertiary eye care center. Arch Ophthalmol. 1996;114:593–9.PubMedCrossRefGoogle Scholar
  19. 19.
    Thean LH, Thompson J, Rosenthal AR. A uveitis register at the Leicester Royal Infirmary. Ophthalmic Epidemiol. 1996;3:151–8.PubMedCrossRefGoogle Scholar
  20. 20.
    Smit RL, Baarsma GS, de Vries J. Classification of 750 consecutive uveitis patients in the Rotterdam Eye Hospital. Int Ophthalmol. 1993;17:71–6.PubMedCrossRefGoogle Scholar
  21. 21.
    Rothova A, Buitenhuis HJ, Meenken C, Brinkman CJ, Linssen A, Alberts C, Luyendijk L, Kijlstra A. Uveitis and systemic disease. Br J Ophthalmol. 1992;76:137–41.PubMedCentralPubMedCrossRefGoogle Scholar
  22. 22.
    Weiner A, BenEzra D. Clinical patterns and associated conditions in chronic uveitis. Am J Ophthalmol. 1991;112:151–8.PubMedCrossRefGoogle Scholar
  23. 23.
    Palmares J, Coutinho MF, Castro-Correia J. Uveitis in northern Portugal. Curr Eye Res. 1990;9(Suppl):31–4.PubMedCrossRefGoogle Scholar
  24. 24.
    Henderly DE, Genstler AJ, Smith RE, Rao NA. Changing pattern of uveitis. Am J Ophthalmol. 1987;103:131–6.PubMedCrossRefGoogle Scholar
  25. 25.
    Almezaine HS, Kangave D, Abu El-Asrar AM. Patterns of uveitis in patients admitted to a university hospital in Riyadh Saudi Arabia. Ocul Immunol Inflamm. 2010;18:424–31.CrossRefGoogle Scholar
  26. 26.
    Rosen PH, Spalton DJ, Graham EM. Intraocular tuberculosis. Eye. 1990;4:486–92.PubMedCrossRefGoogle Scholar
  27. 27.
    Helm CJ, Holland GN. Ocular tuberculosis. Surv Ophthalmol. 1993;38:229–56.PubMedCrossRefGoogle Scholar
  28. 28.
    Biswas J, Madhavan HN, Gopal L, Badrinath SS. Intraocular tuberculosis. Clinocopathologic study of five cases. Retina. 1995;15:461–8.PubMedCrossRefGoogle Scholar
  29. 29.
    Sheu SJ, Shyu JS, Chen LM, Chen YY, Chirn SC, Wang JS. Ocular manifestations of tuberculosis. Ophthalmology. 2001;108:1580–5.PubMedCrossRefGoogle Scholar
  30. 30.
    Sakai J-I, Matsuzawa S, Usui M, Yano I. New diagnostic approach for ocular tuberculosis by ELISA using the cord factor as antigen. Br J Ophthalmol. 2001;85:130–3.PubMedCentralPubMedCrossRefGoogle Scholar
  31. 31.
    Gupta A, Gupta V, Arora S, Dogra MR, Bambery P. PCR-positive tubercular retinal vasculitis. Clinical characteristics and management. Retina. 2001;21:435–44.PubMedCrossRefGoogle Scholar
  32. 32.
    Morimura Y, Okada AA, Kawahara S, Miyamoto Y, Kawai S, Hirakata A, Hida T. Tuberculin skin testing in uveitis patients and treatment of presumed intraocular tuberculosis in Japan. Ophthalmology. 2002;109:851–7.PubMedCrossRefGoogle Scholar
  33. 33.
    Gupta V, Arora S, Gupta A, Ram J, Bambery P, Sehgal S. Management of presumed intraocular tuberculosis: possible role of the polymerase chain reaction. Acta Ophthalmol Scand. 1998;35:237–9.Google Scholar
  34. 34.
    Gupta V, Gupta A, Arora S, Bambery P, Dogra MR, Agarwal A. Presumed tubercular serpiginous-like choroiditis. Clinical presentation and management. Ophthalmology. 2003;110:1744–9.PubMedCrossRefGoogle Scholar
  35. 35.
    Sarvananthan N, Wiselka M, Bibby K. Intraocular tuberculosis without detectable systemic infection. Arch Ophthalmol. 1998;116:1386–8.PubMedGoogle Scholar
  36. 36.
    Abu El-Asrar AM, Al-Kharashi SA. Full panretinal photocoagulation and early vitrectomy improve prognosis of retinal vasculitis associated with tuberculoprotein hypersensitivity (Eales’ disease). Br J Ophthalmol. 2002;86:1248–51.CrossRefGoogle Scholar
  37. 37.
    Wolfensberger TJ, Piguet B, Herbort CP. Indocyanine green angiographic features in tuberculouschorioretinitis. Am J Ophthalmol. 1999;127:350–3.PubMedCrossRefGoogle Scholar
  38. 38.
    Mackensen F, Becker MD, Wiehler U, Max R, Dalpke A, Zimmermann S. QuantiFERON TB-Gold − a new test strengthening long-suspected tuberculous involvement in serpiginous-like choroiditis. Am J Ophthalmol. 2008;146:761–6.PubMedCrossRefGoogle Scholar
  39. 39.
    Gupta V, Gupta A, Rao NA. Intraocular tuberculosis – an update. Surv Ophthalmol. 2007;52:561–87.PubMedCrossRefGoogle Scholar
  40. 40.
    Cimino L, Herbort CP, Aldigeri R, Salvarani C, Boiardi L. Tuberculous uveitis, a resurgent and undiagnosed disease. Int Ophthalmol. 2009;29:67–74.PubMedCrossRefGoogle Scholar
  41. 41.
    Bansal R, Gupta A, Gupta V, Dogra MR, Bambery P, Arora SK. Role of anti-tubercular therapy in uveitis with latent/manifest tuberculosis. Am J Ophthalmol. 2008;146:772–9.PubMedCrossRefGoogle Scholar
  42. 42.
    Tabbara KF. Tuberculosis. Curr Opin Ophthalmol. 2007;18:493–501.PubMedCrossRefGoogle Scholar
  43. 43.
    Al-Mezaine HS, Al-Muammar A, Kangave D, Abu El-Asrar AM. Clinical and optical coherence tomographic findings and outcome of treatment in patients with presumed tuberculous uveitis. Int Ophthalmol. 2008;28:413–23.PubMedCrossRefGoogle Scholar
  44. 44.
    Demirci H, Shields CL, Shields JA, Eagle Jr RC. Ocular tuberculosis masquerading as ocular tumors. Surv Ophthalmol. 2004;49:78–89.PubMedCrossRefGoogle Scholar
  45. 45.
    Bansal R, Gupta A, Gupta V, Dogra MR, Sharma A, Bambery P. Tubercular serpiginous-like choroiditis presenting as multifocal serpiginoidchoroiditis. Ophthalmology. 2012;119:2334–42.PubMedCrossRefGoogle Scholar
  46. 46.
    Gupta A, Bansal R, Gupta V, Sharma A, Bambery P. Ocular signs predictive of tubercular uveitis. Am J Ophthalmol. 2010;149:562–70.PubMedCrossRefGoogle Scholar
  47. 47.
    Ang M, Hedayatfar A, Zhang R, Chee SP. Clinical signs of uveitis associated with latent tuberculosis. Clin Experiment Ophthalmol. 2012;40:689–96.PubMedCrossRefGoogle Scholar
  48. 48.
    Alvarez S, McCabe WR. Extrapulmonary tuberculosis revisited: a review of experience at Boston City and other hospitals. Medicine (Baltimore). 1984;63:25–55.CrossRefGoogle Scholar
  49. 49.
    Rowland K, Guthmann R, Jamieson B, Malloy B. Clinical inquiries. How should we manage a patient with positive PPD and prior BCG vaccination? J Fam Pract. 2006;55:718–20.PubMedGoogle Scholar
  50. 50.
    Pollock NR, Campos-Neto A, Kashino S, Napolitano D, Behar SM, Shin D, Sloutsky A, Joshi S, Guillet J, Wong M, Mardell E. Discordant Quanti FERON-TB Gold test results among US healthcare workers with increased risk of latent tuberculosis infection: a problem or solution? Infect Control Hosp Epidemiol. 2008;29:878–86.PubMedCentralPubMedCrossRefGoogle Scholar
  51. 51.
    Mazurek GH, Zajdowicz MJ, Hankinson AL, Costigan DJ, Toney SR, Rothel JS, Daniels LJ, Pascual FB, Shang N, Keep LW, LoBue PA. Detection of Mycobacterium tuberculosis infection in United States navy recruits using the tuberculin skin test or whole-blood interferon-gamma release assays. Clin Infect Dis. 2007;45:826–36.PubMedCrossRefGoogle Scholar
  52. 52.
    Kurup SK, Buggage RR, Clarke GL, Ursea R, Lim WK, Nussenblatt RB. Gamma interferon assay as an alternative to PPD skin testing in selected patients with granulomatous intraocular inflammatory disease. Can J Ophthalmol. 2006;41:737–40.PubMedCrossRefGoogle Scholar
  53. 53.
    Ang M, Htoon HM, Chee SP. Diagnosis of tuberculous uveitis: clinical application of an interferon-gamma release assay. Ophthalmology. 2009;116(7):1391–6.PubMedCrossRefGoogle Scholar
  54. 54.
    Babu K, Satish V, Satish S, et al. Utility of QuantiFERON TB gold test in a South Indian patient population of ocular inflammation. Indian J Ophthalmol. 2009;57:427–30.PubMedCentralPubMedCrossRefGoogle Scholar
  55. 55.
    Gineys R, Bodaghi B, Carcelain G, et al. QuantiFERON-TB gold cut-off value: implications for the management of tuberculosis-related ocular inflammation. Am J Ophthalmol. 2011;152(3):433–40.PubMedGoogle Scholar
  56. 56.
    Llorenç V, González-Martin J, Keller J, Rey A, Pelegrín L, Mesquida M, Adán A. Indirect supportive evidence for diagnosis of tuberculosis-related uveitis: from the tuberculin skin test to the new interferon gamma release assays. Acta Ophthalmol. 2013;91:e99–107.PubMedCrossRefGoogle Scholar
  57. 57.
    Honoré-Bouakline S, Vincensini JP, Giacuzzo V, Lagrange PH, Hermann JL. Rapid diagnosis of extrapulmonary tuberculosis by PCR: impact of sample preparation and DNA extraction. J Clin Microbiol. 2003;41:2323–9.PubMedCentralPubMedCrossRefGoogle Scholar
  58. 58.
    Mehta S. Role of computed chest tomography (CT scan) in tuberculous retinal vasculitis. Ocul Immunol Inflamm. 2002;10:151–5.PubMedCrossRefGoogle Scholar
  59. 59.
    Doycheva D, Deuter C, Hetzel J, et al. The use of positron emission tomography/CT in the diagnosis of tuberculosis-associated uveitis. Br J Ophthalmol. 2011;95:1290–4.PubMedCrossRefGoogle Scholar
  60. 60.
    Abu El-Asrar AM, Abouammoh M, Al-Mezaine HS. Tuberculous uveitis. Int Ophthalmol Clin. 2010;50:19–39.PubMedCrossRefGoogle Scholar
  61. 61.
    Abu El-Asrar AM, Almezaine HS. Anti-tuberculoustherapy combined with systemic corticosteroids improves retinal sensitivity in patients with active presumed tuberculous choroiditis. Int Ophthalmol. 2010;30:567–76.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Ahmed M. Abu El-Asrar
    • 1
  • Marwan Abouammoh
    • 1
  • Hani S. Al-Mezaine
    • 1
  1. 1.Department of OphthalmologyCollege of Medicine, King Saud University, KAUHRiyadhSaudi Arabia

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